Cranial CT is a mandatory tool to exclude asymptomatic cerebral hemorrhage in elderly patients on anticoagulation.

Background: Traumatic brain injury (TBI) after falls causes death and disability with immense socioeconomic impact through medical and rehabilitation costs in geriatric patients. Diagnosing TBI can be challenging due to the absence of initial clinical symptoms. Misdiagnosis is particularly dangerous in patients on permanent anticoagulation because minimal trauma might result in severe intracranial hemorrhage. The aim of this study is to evaluate the diagnostic necessity of cranial computed tomography (cCT) to rule out intracranial hemorrhage, particularly in the absence of neurologic symptoms in elderly patients on permanent anticoagulation in their premedication. Patients and methods: Retrospective cohort analysis of elderly trauma patients (≥ 65 years) admitted to the emergency department (ED) of the level-1-trauma center of the University Hospital Frankfurt from 01/2017 to 12/2019. The study included patients who suffered a ground-level fall with suspected TBI and subsequently underwent CT because of preexisting anticoagulation. Results: A total of 227 patients met the inclusion criteria. In 17 of these patients, cCT showed intracranial hemorrhage, of which 14 were subdural hematomas (SDH). In 8 of the patients with bleeding showed no clinical symptoms, representing 5% (n = 160) of all symptom-free patients. Men and women were equally to suffer a post-traumatic hemorrhage. Patients with intracranial bleeding were hospitalized for 14.5 (±10.4) days. Acetylsalicylic acid (ASA) was the most prescribed anticoagulant in both patient cohorts-with or without intracerebral bleeding (70.6 vs. 77.1%, p = 0.539). Similarly, patients taking new oral anticoagulant (NOAC) (p = 0.748), coumarins, or other platelet inhibitors (p > 0.1) did not show an increased bleeding incidence. Conclusion: Acetylsalicylic acid and NOAC use are not associated with increased bleeding risk in geriatric trauma patients (≥ 65 years) after fall-related TBI. Even in asymptomatic elderly patients on anticoagulation, intracranial hemorrhage occurs in a relevant proportion after minor trauma to the head. Therefore, cCT is an obligatory tool to rule out cerebral hemorrhage in elderly patients under anticoagulation.

[Metabolic Tumor Imaging in Head and Neck Oncology]. / Metabolische Tumorbildgebung bei muskosalen Kopf- und Hals-Karzinomen.

Metabolic Tumor Imaging in Head and Neck Oncology Abstract. Fluorodeoxyglucose with position emission tomography combined with CT or MRI (FDG-PET) has become an important diagnostic and staging method in head and neck squamous cell carcinoma. Some regard FDG-PET merely as a tool able of displaying cancer cells as bright spots on imaging. However, quantification of FDG uptake can be used as a surrogate marker for tumor aggressiveness and predict tumor response before (chemo)-radiation. The FDG uptake of the primary tumor can also predict surgical outcome measures such as depth of invasion, occult nodal metastasis, or bone invasion for oral cancer and/or organ preservation in hypopharyngeal cancer.

[Cinematic Rendering in Cone Beam Computed Tomography: Advanced 3D Reconstructions of Dental and Maxillofacial Pathologies]. / Cinematic Rendering in der Digitalen Volumentomografie.

Cinematic rendering (CR) is a novel 3D visualisation technique, which provides photorealistic image reconstructions with a high level of image details. Aim of this case series is to show the application of CR in Cone Beam Computed Tomography (CBCT) in dentomaxillofacial pathologies. Four exemplary CBCTs of clinical dentomaxillofacial cases were selected. 3D CR reconstructions were generated from the CBCT by using a vendor-provided standard CR software. Cases include 1) external tooth resorption, 2) ankylosed maxillary molar tooth, 3) giant cell-associated osteolytic lesion of the mandible, 4) unilateral cleft lip/palate with additional skeletofacial deformity. CBCTs of four patients showing dental and osseous pathologies were successfully reconstructed. Overall, a subjectively improved 3D understanding of the presented pathologies was observed. The CR images seem to present more plasticity, giving a better feeling for the spatial depth of the tissue. CR can be applied to CBCT images in dentomaxillofacial patients. The photorealistic appearance might improve the understanding of complex anatomy or pathology, could facilitate patient communication, and might be helpful for advanced medical education. We see potential in the use of CR for additional 3D visualization. The actual image diagnosis is done in the classic sectional planes. The significance of CR reconstruction for image diagnostics must be investigated in appropriate studies.

[An Uncommon Cerebral Lesion in Computed Tomography]. / Ungewöhnliche zerebrale Läsion in der Computertomografie.

We report the case of a 84-year-old man who suffered a hematoma of the septum pellucidum due to a fall. The development of the septum pellucidum and its implications on pathomechanisms in head injury are discussed. In the setting of trauma, a reliable differentiation to other septal lesions can be impossible in computed tomography alone, unless earlier examinations are availabe for comparison. Additional magnetic resonance imaging may be warranted in case of vicinity of the lesion to the interventricular foramina.

[Metastases in the temporomandibular joint: a review from 1954 to 2013. Rare causes for temporomandibular disorders]. / Metastasen im Kiefergelenk: Ein Literaturüberblick von 1954 bis 2013. Seltene Ursachen von Kiefergelenkbeschwerden.

INTRODUCTION: Metastatic lesions make up approximately 1% of all oral cancers.A comparatively rare location is the temporomandibular joint.Leading symptoms can be misdirecting, especially in the beginning,because they are frequently similar or even identical to those occurring in temporomandibular disorders. Therefore it can be quite difficult to confirm the diagnosis of a TMJ metastasis.delayed initiation of therapy and thus a poor prognosis are often the results. MATERIAL AND METHODS: A review of the literature from 1954 to 2013 was realized and the published cases between 1954 and January 2013 were evaluated.The results were analyzed according to gender distribution, age,first symptoms, location of the primary tumor, as well as to the occurrence of malignancies in the patients' medical history. RESULTS: The research identified sixty-six patients. Tumors of the lung and breast were the main starting points of the metastatic spread. The histopathological workup showed above all the diagnosis of an adenocarcinoma. In all of the cases, unspecific symptoms led to the diagnosis of a metastatic disease. CONCLUSION AND SIGNIFICANCE: In the case of nonspecific TMJ affection, diagnostics should consider less-frequent diagnoses, such as the presence of metastasis.A clinical differentiation by additional symptoms like swelling, unexplained weight loss and night sweats, as well as a tumor disease in the past or failure of conservative treatment can provide additional indications. If there is reasonable suspicion,extended medical imaging and diagnostic measures must be performed to allow early treatment initiation and a better prognosis.